# BERRIOS ANTUNA FAMILY PRACTICE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578702205
- **Authorized official:** DR. EMILIO J BERRIOS-ANTUNA MD (OWNER)
- **Authorized official phone:** (313) 574-9266

## Contact information

- **Practice address:** 6224 MICHIGAN AVE, DETROIT, MI 48210-2953
- **Practice address phone:** (313) 574-9266
- **Mailing address:** 6224 MICHIGAN AVE, DETROIT, MI 48210-2953
- **Mailing address phone:** (313) 574-9266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 4301088825 | MI | Yes |

## Other

- **Enumeration date:** 02/20/2009
- **Last updated:** 12/21/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4301088825 | LICENSE NUMBER | MI |